[Congressional Record Volume 153, Number 173 (Thursday, November 8, 2007)]
[Senate]
[Pages S14182-S14184]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   UNANIMOUS CONSENT REQUEST--S. 2168

  Mr. DURBIN. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of Calendar No. 459, S. 2168; 
further that the committee amendments be agreed to; the bill, as 
amended, be read the third time and passed; the motion to reconsider be 
laid upon the table, with no intervening action or debate; that any 
statements relating to the bill be printed in the Record.
  The PRESIDING OFFICER. Is there objection?
  Mr. CRAIG. Mr. President, I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. CRAIG. Mr. President, I wish to discuss my opposition to two 
bills reported by the Veterans' Affairs Committee, but I continue to 
hope we can resolve the concerns I will address today.
  Unanimous consent has been sought to pass two controversial bills: S. 
1233,

[[Page S14183]]

the Veterans Traumatic Brain Injury and Health Programs Improvement 
Act, and S. 1315, the Veterans Benefits Enhancement Act. Although both 
bills are well-intended, they contain unacceptable provisions that I 
believe would be detrimental to the care our returning wounded warriors 
deserve and currently receive at VA facilities. At the very least, 
these provisions are controversial enough to merit considerable floor 
debate, and therefore I have no alternative but to oppose the unanimous 
consent agreement.
  In the past, the Veterans' Affairs Committee has worked in a 
bipartisan fashion to settle differences at the committee level and 
avoid taking up Senate floor time to debate and amend significant 
veterans legislation. Unfortunately, that is not the case with S. 1233 
and S. 1315. Even so, I do not want to close the door on these bills 
because each has numerous provisions that I support or have sponsored 
in the past. Both bills contain provisions to enhance the care our 
veterans receive, and I believe that if we can return to the 
negotiating table, we can find an acceptable solution to both my 
concerns and the concerns of my colleagues.
  I would like to address these two bills separately because they 
clearly raise different issues. S. 1315, the Veterans Benefits 
Enhancement Act, contains a number of important provisions that will 
enhance benefits and services for America's combat veterans returning 
from the war in Iraq and the global war on terror and for all veterans 
with service-connected disabilities.
  Among those provisions that I believe are important and responsible 
for us to provide our veterans are retroactive payments under the 
traumatic injury protection program of Servicemembers' Group Life 
Insurance for those injured outside of Operation Iraqi Freedom or 
Operation Enduring Freedom theaters of operation between October 7, 
2001, and December 1, 2005. This will ensure that soldiers injured on 
their way to fight in OIF or OEF, but not in the theater of combat, are 
eligible for these benefits.
  Other provisions in this bill will expand the housing grant 
assistance program available to those with severe burn injuries--
injuries that are a sad and terrible reality of our current conflict. 
We must continue to adapt and modify the benefits our veterans receive 
based on the changing environment in which our soldiers fight; these 
provisions are a great example of our ability to do so.
  However, there is a section within this bill that I vigorously 
oppose. In fact, this provision is the sole reason for my unwillingness 
to support the bill, and I would like to explain it here today. 
Included in S. 1315 is a section that would expand benefits to certain 
Filipino veterans residing both in the United States and abroad. I have 
supported, and continue to support, improving benefits for Filipino 
veterans who fought under U.S. command during World War II. However, I 
believe that the approach taken in this section with respect to special 
pension benefits for non-U.S. citizens and non-U.S. resident Filipino 
veterans and surviving spouses goes beyond the intent of veterans 
benefits. Further, I do not believe such a provision would have the 
support of the American people.

  Let me explain.
  Pension benefits for veterans in the United States are paid at a 
maximum annual rate of $10,929 for those with no dependents, $14,313 
for those with dependents, and $7,329 for a surviving spouse. The 
maximum VA pension represents somewhere between 16 percent and 31 
percent of the annual U.S. household income of $46,000. Contrast that 
with the average Philippines household income of $2,800. The special 
pension for Filipino veterans in S. 1315 would amount to an astounding 
86 percent to 161 percent of the Philippines household income.
  This legislation did not take into account the vast discrepancy 
between the standard of living in the United States and the 
Philippines. By refusing to look at the purchasing power of the 
benefits being provided here, this legislation would pay veterans in 
the Philippines far more in benefits and pension than we pay our own 
veterans. It is especially ironic that a bill intending to treat 
Filipino veterans equitably would create such a dramatic inequity for 
our U.S. veterans.
  Furthermore, the offset that S. 1315 uses to ensure that the bill is 
in compliance with congressional budget rules would have the effect of 
reducing pension amounts to elderly, poor, and disabled veterans 
predominantly residing in the United States. I acknowledge there is 
considerable agreement that these extra payments for certain categories 
of veterans were never contemplated by Congress and, therefore, are not 
justified. However, if presented with the choice of using the savings 
from eliminating these payments to provide extra pension assistance to 
low-income veterans in the United States or to underwrite the kind of 
special benefit I described earlier, I believe the American people 
would choose to take care of our own veterans' pensions first--and when 
providing benefits to the Filipino veterans, they would insist that 
those benefits are adjusted to reflect the real differences in costs of 
living between our two countries.
  The other bill I would like to address today is S. 1233, the Veterans 
Traumatic Brain Injury and Health Programs Improvement Act. I was 
originally a cosponsor of this legislation and would very much like to 
see it move forward and be signed into law. However, there are a few 
provisions that are premature, considering the current capacity of our 
VA medical facilities, and I hope my colleagues will agree these 
provisions should be deferred to a later date.
  The provisions I must regrettably oppose at this time are the 
proposed admittance of Priority 8 and Priority 4 veterans into the VA 
health system. To ensure VA can meet our Nation's obligation to 
veterans with combat or military-related disabilities, lower income 
veterans, and those needing specialized care like veterans who are 
blind or have spinal cord injuries--to ensure appropriate care for 
these veterans, former VA Secretary Anthony Principi suspended 
additional enrollments for veterans with the lowest statutory priority. 
This category includes veterans who are not being compensated for a 
military-related disability and who have higher incomes.
  It has become very clear, especially over the last few years, that 
servicemembers returning from Iraq and Afghanistan are enduring lengthy 
waiting times for care. In the face of such assessments, I do not 
understand why we should be in a rush to open up the health care system 
to hundreds of thousands--if not millions--of new patients who by 
definition are not in need of immediate assistance or can afford 
private health care.
  Moreover, it appears that the provision in this bill would open VA to 
new enrollees on the day the legislation is signed into law. Yet no 
plan is required to ensure that the enrollment process would be orderly 
and executed so as to minimize impacts on current patients, nor is 
there any requirement that the necessary funding be available prior to 
its implementation. Instead, VA would simply open the doors and wait to 
see who arrives. I believe that is irresponsible and unfair to the 
current enrollees who are in most need of care.
  We should forgo opening up the VA health care system until such a 
time as the Secretary of the VA can certify that troops returning from 
Iraq and Afghanistan are being provided timely, high-quality health 
care and neither timeliness nor quality would suffer because of newer 
enrollees, such as Priority 8 veterans. VA's health care system was 
created primarily to care for ``he who shall have borne the battle.'' 
Congress should ensure that this unique group of veterans is not unduly 
burdened by any new influx of higher income veterans with no military-
related disabilities.
  Some Senators may contend that money can overcome any obstacle to 
providing all veterans with health care through VA. However, since any 
money provided for new patients would be used to acquire new staff, new 
equipment, and new space, it is important to know if those resources 
are even available.
  Let's first consider where VA will find the new staff needed to care 
for the huge influx of patients this legislation proposes. It is widely 
known that our Nation has a shortage of primary care physicians and 
nurses to provide basic health care services in non-VA facilities. This 
issue was made clear in a July 2007 report from the Health Research 
Institute of Pricewater-

[[Page S14184]]

houseCoopers which showed that the United States will be short nearly 1 
million nurses and 24,000 physicians by 2020. In this environment, 
simply finding new staff to hire will be a challenge for any health 
care system, including VA.
  Further, assuming the requisite staff can be found, I am skeptical 
that VA has the necessary clinical space in which to provide more 
primary and specialty care services. I am also skeptical that many VA 
facilities could open the additional operating rooms, postsurgical 
recovery units, and intensive care units that would be required with a 
large increase in patients.
  Last, the Congressional Budget Office has scored this legislation at 
$1.3 billion for the first year of inclusion of just Priority 8s into 
the system, or $8.8 billion from 2008 to 2012. However, it must be 
noted that CBO assumed Priority 8s would only be allowed to enroll in 
the system for 1 year, after which enrollment would be closed. Based on 
past experience, it is highly unlikely that Congress will maintain such 
a 1-year limit and virtually certain the costs would continue to rise 
above and beyond what CBO projected for implementation of this 
legislation.
  When the VA health care system can support a substantial increase in 
patients, I will be more than happy to address this issue with my 
colleagues. However, at this point, when even our returning wounded 
warriors are forced to sit in long waiting lines to receive care, it 
would be grossly irresponsible for us to move forward with this 
legislation, and I must therefore continue to object to its passage.
  The underlying legislation also contains a provision waiving required 
inpatient care copayments for Priority 4 veterans with higher incomes. 
I have concerns with this provision as well.
  The passage of this provision would change VA's policy of charging a 
copayment for the care of a nonservice-connected condition, to allow an 
exception for circumstances that have nothing to do with a veteran's 
ability to pay. A grateful Nation has seen fit to provide cost-free 
care for service-connected conditions and has generously extended the 
same benefit to those with limited financial resources. However, with 
this provision, it would no longer be relevant whether veterans could 
afford to contribute even modestly to the cost of their care. Rather, 
cost-free care would be provided to a population of patients based 
solely on a particular health condition. That is a bad precedent.
  If this legislation passes, I believe that in the not too distant 
future, it will be strongly argued by higher income, service-connected 
veterans that their benefit--cost-free care for service-connected 
conditions--has been diluted. And the dilution is not fair because now 
they would be charged for nonservice-connected care, while those with 
similar economic means in Priority 4 would not be forced to make 
copayments for the same type of care. With this provision as precedent, 
a future Congress will be forced to concede to the dilution and its 
unfairness. Then they will probably be forced to accede to the change.
  All that being said, I would like to make sure that my colleagues 
understand that while I am objecting to passage of these bills in their 
current form, I sincerely hope and believe that accommodations can be 
made so that we can pass these bills and get much needed improvements 
made to the VA health care and benefits systems. Both bills have very 
meaningful and well-intentioned provisions that I support; 
unfortunately, there are a few provisions that I believe are 
detrimental or simply unfair to our Nation's veterans, and for that 
reason I am here on the floor of the Senate explaining my reasons for 
objecting to passage of these bills.
  I look forward to discussing with my colleagues ways that we can move 
these bills and reach a compromise that benefits our brave veterans.
  Mr. DURBIN. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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